Article

Referral to cardiac rehabilitation and secondary prevention programs
remains very low, despite evidence suggesting strong clinical efficacy. To
develop evidence-based interventions to promote referral, the complex factors and
processes influencing referral need to be better understood. DESIGN: We performed
a systematic review using qualitative meta-synthesis. METHODS: A comprehensive
search of 11 databases was conducted. To be included, studies had to contain a
qualitative research component wholly or in a mixed method design. Population
specific data or themes had to be extractable for referral to programs. Studies
had to contain extractable data from adults >18 years and published as full
papers or theses during or after 1995. RESULTS: A total of 2620 articles were
retrieved: out of 1687 studies examined, 87 studies contained data pertaining to
decisions to participate in programs, 34 of which included data on referral.
Healthcare professional, system and patient factors influenced referrals. The
main professional barriers were low knowledge or scepticism about benefits, an
over-reliance on physicians as gatekeepers and judgments that patients were not
likely to participate. Systems factors related to territory, remuneration and
insufficient time and workload capacity. Patients had limited knowledge of
programs and saw physicians as key elements of referral but found the process of
attaining a referral confusing and challenging.
CONCLUSIONS: The greatest
increases in patient referral to programs could be achieved by allowing referral
from non-physicians or alternatively, automatic referral to a choice of hospital
or home-based programs. All referring health professionals should receive
educational outreach visits or workshops around the ethical and clinical aspects of programs.

Langue : ANGLAIS